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Form 9-1483 Agreement Number:
<br />(Aug. 1994)
<br />AGREEMENT FOR INSTALLATION, MAINTENANCE AND
<br />USE OF A TEST HOLE AND/OR OBSERVATION WELL ON
<br />PRIVATE OR PROPERTY
<br />THIS AGREEMENT is entered into this day of , 19 , by and between
<br />hereinafter called "Licensor," and the United States of
<br />America, by and through the U.S. Geological Survey, U.S. Department of the Interior, hereinafter called "Licensee,"
<br />pursuant to the Act of December 24, 1942, as amended (43 U.S.C. sec. 36b).
<br />WITNESSETH:
<br />1. Licensor, for and in consideration of the faithful performance by Licensee of all covenants and conditions
<br />herein contained and payment of the amount hereinafter provided, hereby consents and agrees to the excavation,
<br />installation, maintenance, and exclusive use of (describe physical characteristics of hole and/or well, maintenance
<br />facilities, and purposes of excavation, use and maintenance.)
<br />hereinafter collectively referred to as "Structure," by the Licensee upon and over the property of the Licensor as
<br />described in Paragraph 2 hereof, and the Licensor grants the right of ingress to and egress from the said Structure
<br />and property described herein for the purpose stated herein.
<br />This test hole is an opening which extends into the earth and is produced by drilling or augering methods.
<br />This observation well is a hole which extends into the earth and is produced by drilling or augering, which
<br />may or may not be cased or screened, and exists solely for the purpose of obtaining geologic and hydrologic
<br />information.
<br />2. The said Structure shall be located on the property of Licensor as shown on attached drawing and further
<br />described as follows: (site location)
<br />3. Excavation and/or installation of said structure shall begin within days or a mutually agreeable time
<br />after the effective date of this agreement. The said Structure and appurtenances thereof shall be excavated, installed
<br />and maintained in a good, safe, diligent and workmanlike manner.
<br />4. The said Structure and appurtenances and all equipment and tools for the maintenance and use thereof placed
<br />in or upon said described property shall remain the property of the Licensee and shall be removed, filled and/or
<br />plugged, etc., by the Licensee at its own cost and expense within a reasonable time after the expiration of this agree-
<br />ment or any renewal thereof. Upon removal, filling and/or plugging, etc. of said Structure and appurtenances the
<br />Licensee shall restore said property to, as nearly as possible, the same state and condition existing prior to the
<br />excavation, and/or installation of said Structure and its appurtenances.
<br />5. The Licensee agrees to cooperate, to the extent by law, in the submittal of all claims for alleged loss, injuries,
<br />or damages to persons or property arising from the acts of Licensee's employees, acting within the scope of their
<br />employment, in the excavation, installation, use, maintenance, and/or removal of said Structure appurtenances, equip
<br />ment and tools pursuant to the Federal Tort Claims Act (28 U.S.C., 2671 et seq.)
<br />Figure 3. Sample of Form 9-1483 (Aug. 1994), "Agreement for Installation, Maintenance and Use of a Test Hole
<br />and/or Observation Well on Private or Property." (Available from GSA, National Forms Center, Warehouse
<br />4, Dock 1, 4900 South Hemphill St., Ft. Worth, TX 76115 and as a FrameMaker template. Sample form not a bind-
<br />ing document.)
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